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Background Current evidence suggests that even in high-income countries such as Sweden, there are socioeconomic differences in children’s participation in physical activity. While family-based programmes appear promising to encourage physical activity, there is a lack of knowledge on how to engage families in such programmes, particularly in socioeconomically disadvantaged areas. The Open Health-Promoting Activities programme was launched to promote physical activity outdoors and health equity for children and their families in these areas. This study aims to explore parents’ experiences with the Open Health-Promoting Activities programme in socioeconomically disadvantaged areas, focusing on family engagement in physical activity and perceived changes in family dynamics. Methods A qualitative design with an ethnographic approach was employed. In line with an ethnographic approach, the research team conducted 15 participant observations of the programme sessions on Saturdays during Spring 2022. Field notes were compiled during the observations, which provided contextual information for individual interviews with 12 programme participants. These interviews were conducted after the researchers attended the programme. The participants were adults/parents who participated in the programme with one or more of their children. An inductive reflexive thematic analysis was used to analyse the field notes and interviews. Results The analysis identified three main themes: (1) prioritising children’s equal engagement in physical activity, (2) helping parents promote children’s healthy lifestyles, and (3) improving family dynamics through engagement in physical activity. Each theme captures an aspect of the programme that parents perceived as essential to facilitating their family’s engagement in the programme. All the themes are interconnected and form the basis for improving family dynamics. Conclusion To develop tailored family-based programmes in socioeconomically deprived communities, it is crucial to understand parents’ experiences and perceptions of aspects that facilitate their children’s engagement in physical activity. The findings suggest that emphasising equal opportunities, a safe space approach and participation are essential for increasing family engagement in physical activity. These elements also supported increasing parents’ awareness of their children’s need to be active and have fun together.

Middle-aged adults engaging in unhealthy lifestyle behaviors are at higher risk of chronic diseases. However, little is known about the co-occurrence of these behaviors and their determinants. This cohort study examined the co-occurrence of unhealthy lifestyle behaviors (alcohol consumption, diet, physical inactivity, and smoking) in 30,154 middle-aged adults and their associations with sociodemographic factors, social support, and disease history. Alcohol use was measured by the AUDIT, diet by the MiniMeal-Q, and physical inactivity and smoking by single questions. Participants had a mean age of 58 years, with 51% being female. Of them, 14% had no unhealthy behaviors, 38% had one, 36% had two, 10% had three, and 2% had all four. The most common co-occurrence was between physical inactivity and poor diet (38%). Higher education decreased the likelihood of having three or four unhealthy behaviors, while financial difficulties, having no one around who appreciated one’s efforts, and suffering of a lung disease increased it. In conclusion, middle-aged adults exhibit varying levels of unhealthy lifestyle behaviors. Higher education is linked to reduced engagement in multiple unhealthy behaviors, whereas financial strain, lower quality of social support, and lung disease increase the risk.

ObjectiveTo evaluate long-term risk of first cardiovascular (CV) events, CV deaths and all-cause deaths in community-dwelling participants of a cardiovascular disease (CVD) prevention programme delivered in a primary care setting.MethodsIndividuals who visited a primary healthcare service in Sollentuna (Sweden) and agreed to participate in the programme between 1988 and 1993 were followed. They had at least one CV risk factor but no prior myocardial infarction and received support to increase physical activity using the programme Physical Activity on Prescription and to adopt health-promoting behaviours including cooking classes, weight reduction, smoking cessation and stress management. Participants (n=5761) were compared with a randomly selected, propensity score-matched reference group from the general population in Stockholm County (n=34 556). All individuals were followed in Swedish registers until December 2011.ResultsIn the intervention group and the reference group there were 698 (12.1%) and 4647 (13.4%) first CV events, 308 (5.3%) and 2261 (6.5%) CV deaths, and 919 (16.5%) and 6405 (18.5%) all-cause deaths, respectively, during a mean follow-up of 22 years. The HR (95% CI) in the intervention group compared with the reference group was 0.88 (0.81 to 0.95) for first CV events, 0.79 (0.70 to 0.89) for CV deaths and 0.83 (0.78 to 0.89) for all-cause deaths.ConclusionsParticipation in a CVD prevention programme in primary healthcare focusing on promotion of physical activity and healthy lifestyle was associated with lower risk of CV events (12%), CV deaths (21%) and all-cause deaths (17%) after two decades. Promoting physical activity and healthy living in the primary healthcare setting may prevent CVD.

Introduction and aim Ethnically diverse neighborhoods encounter pronounced inequalities, including housing segregation and limited access to safe outdoor spaces. Residents of these neighborhoods face challenges related to physical inactivity, including sedentary lifestyles and obesity in adults and children. One approach to tackling health inequalities is through family-based programs tailored specifically to these neighborhoods. This study aimed to investigate parents’ experiences and perceptions of the family-based Open Activities, a cost-free and drop-in program offered in ethnically diverse and low socioeconomic neighborhoods in Sweden. Methods Researchers’ engagement in 15 sessions of the Open Activities family-based program during the spring of 2022, and individual interviews with 12 participants were held. Data were analyzed using reflexive thematic analysis. Results The analysis resulted in three main themes and seven sub-themes representing different aspects of the program’s meaning to the participants as parents, their families, and communities. The main themes describe how parents feel valued by the program, which actively welcomes and accommodates families, regardless of cultural differences within these neighborhoods. The themes also show how cultural norms perceived as barriers to participation in physical activity can be overcome, especially by mothers who express a desire to break these norms and support girls’ physical activity. Additionally, the themes highlight the importance of parents fostering safety in the area and creating a positive social network for their children to help them resist criminal gang-related influences. Conclusions The program’s activities allowed parents to connect with their children and other families in their community, and (re)discover physical activity by promoting a sense of community and safety. Implications for practice include developing culturally sensitive activities that are accessible to and take place in public spaces for ethnically diverse groups, including health coordinators that can facilitate communication between groups. To enhance the impact of this program, it is recommended that the public sector support the creation of cost-free and drop-in activities for families who are difficult to reach in order to increase their participation in physical activity, outreach, and safety initiatives.

We aimed to investigate whether different measures of obesity could similarly predict atrial fibrillation, and whether the atrial fibrillation risk associated with obesity is dependent on presence of metabolic syndrome. We performed our study in a population-based longitudinal cardiovascular study, comprising 1 924 men and 2 097 women, aged 60 years, from Stockholm. Body mass index, waist circumference, sagittal abdominal diameter and components of metabolic syndrome (systolic- and diastolic blood pressure, fasting glucose, triglycerides, high-density lipoprotein-cholesterol) were recorded at baseline. Participants were classified by their body mass index (normal weight, overweight or obese), waist circumference (normal, semi-elevated or elevated), and according to presence of metabolic syndrome. Atrial fibrillation risk was estimated by Cox proportional hazards regression models, adjusted for common atrial fibrillation risk factors, expressed as HR and 95% CI. During a mean follow-up of 13.6 years, 285 incident atrial fibrillation cases were recorded. One standard deviation increment of each obesity measure was associated with increased atrial fibrillation risk as: body mass index 1.25 (1.12 - 1.40), waist circumference 1.35 (1.19 - 1.54) and sagittal abdominal diameter 1.28 (1.14 - 1.44). Compared to normal weight subjects without metabolic syndrome, increased atrial fibrillation risk was noted for overweight subjects with metabolic syndrome, 1.67 (1.16 - 2.41), obese subjects without metabolic syndrome, 1.75 (1.11 - 2.74) and obese subjects with metabolic syndrome, 1.92 (1.34 - 2.74). Compared to subjects with normal waist circumference without metabolic syndrome, subjects with elevated waist circumference and metabolic syndrome suffered increased atrial fibrillation risk, 2.03 (1.44 - 2.87). Body mass index, waist circumference and sagittal abdominal diameter could similarly predict atrial fibrillation. Obesity was associated with an increased atrial fibrillation risk regardless of metabolic syndrome, whereas overweight and elevated waist circumference was associated with increased atrial fibrillation risk only if metabolic syndrome was present.

Background Healthy lifestyle habits, including physical activity (PA), are associated with a broad range of positive psychosocial and physical health benefits. However, there are challenges involved in reaching vulnerable groups in socioeconomically disadvantaged areas. There is a lack of research on family-based PA interventions, specifically considering psychosocial health. The purpose of this study was to explore how families experienced psychosocial aspects of health after participation in a family-based programme, A Healthy Generation. Methods A Healthy Generation is a health-promoting, family-based programme delivered in collaboration with local municipalities and sport associations in socioeconomically disadvantaged areas in Sweden. Families with children in grade 2 (8–9 years), including siblings, participate in health-promoting activities, including activity sessions, healthy meals, health information and parental support groups. Data was collected through interviews with parents and children ( n  = 23) from a controlled pilot trial of the programme. Interviews were audio recorded, transcribed and analysed using a phenomenological hermeneutical method. Results Three themes and seven sub-themes emerged. The themes were: “ A sense of belongi ng”, “ Awareness of one’s role as a parent ” and “ Inspiration towards new and healthier behaviours ”. In terms of A sense of belonging , participation in the programme was the families own free zone, where they also had the opportunity of being together with other families in the programme. For participants that were isolated and lacked a social network, their participation helped them towards social participation. During the programme, parents created an Awareness of one’s role as a parent, with new insights on how to act as a parent and they also negotiated differences between each other. Participation in the programme contributed to Inspiration towards new and healthier behaviours such as experience-based insights and healthy lifestyle changes. Conclusions This study highlights the importance of co-participation in family-based health-promoting programmes to enhance psychosocial health among families in socioeconomically disadvantaged areas. The results give new insights into participants’ experiences of psychosocial aspects of health after participation in a family-based PA programme. This knowledge can contribute to the understanding of how to design health-promoting, family-based interventions to promote psychosocial health in socioeconomically disadvantaged areas. Trial registration ISRCTN ISRCTN11660938 . Retrospectively registered 23 September 2019.

There is a considerable heterogeneity in blood cell telomere length (TL) for individuals of similar age and recent studies have revealed that TL changes by time are dependent on TL at baseline. TL is partly inherited, but results from several studies indicate that e.g. life style and/or environmental factors can affect TL during life. Collectively, these studies imply that blood cell TL might fluctuate during a life time and that the actual TL at a defined time point is the result of potential regulatory mechanism(s) and environmental factors. We analyzed relative TL (RTL) in subsequent blood samples taken six months apart from 50 individuals and found significant associations between RTL changes and RTL at baseline. Individual RTL changes per month were more pronounced than the changes recorded in a previously studied population analyzed after 10 years' follow up. The data argues for an oscillating TL pattern which levels out at longer follow up times. In a separate group of five blood donors, a marked telomere loss was demonstrated within a six month period for one donor where after TL was stabilized. PCR determined RTL changes were verified by Southern blotting and STELA (single telomere elongation length analysis). The STELA demonstrated that for the donor with a marked telomere loss, the heterogeneity of the telomere distribution decreased considerably, with a noteworthy loss of the largest telomeres. In summary, the collected data support the concept that individual blood cell telomere length is a dynamic feature and this will be important to recognize in future studies of human telomere biology.

Fatty acid composition of serum lipids and adipose tissue triacylglycerols (AT-TAG) partly reflect dietary fatty acid intake. The fatty acid composition is, besides the diet, also influenced by desaturating enzymes that can be estimated using product-to-precursor fatty acid ratios. The interrelationships between desaturase indices derived from different serum lipid fractions and adipose tissue are unclear, as well as their associations with obesity and insulin resistance. We aimed to investigate cross-sectional correlations between desaturase indices as measured in serum lipid fractions (phospholipids; PL and free fatty acids; FFA) and in adipose tissue (AT-TAG). In a population-based sample of 301 healthy 60-year-old men various desaturase indices were assessed: stearoyl-CoA-desaturase (16:1n-7/16:0; SCD-16 and 18:1n-9/18:0; SCD-18, respectively), delta-6-desaturase (20:3n-6/18:2n-6; D6D) and delta-5-desaturase (20:4n-6/20:3n-6; D5D). Correlations with BMI and insulin resistance (HOMA-IR) were also examined. SCD-16 and D5D were significantly correlated between fractions and tissues (all r > 0.30), whereas SCD-18 and D6D were not. Desaturase indices in serum FFA and AT-TAG were significantly correlated; SCD-16 (r = 0.63), SCD-18 (r = 0.37), and D5D (r = 0.43). In phospholipids, SCD-16 was positively correlated to BMI (r = 0.15), while D5D negatively to both BMI (r = -0.30) and HOMA-IR (r = -0.31), all p < 0.01. D6D in both phospholipids and AT-TAG was positively correlated to HOMA-IR and BMI (all p < 0.01). In conclusion, SCD-1 and D5D activity indices showed overall strong correlations between lipid pools. SCD-1 activity index in adipose tissue is best reflected by 16:1/16:0-ratio in serum FFA, but associations with obesity and insulin resistance differ between these pools. D5D in PL was inversely related to obesity and insulin resistance, whereas D6D index showed positive associations.

Purpose Fatty acid composition in blood and adipose tissue (AT) is a useful biomarker of dietary fat quality. However, circulating saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) have been proposed to also reflect carbohydrate-induced de novo lipogenesis (DNL) and stearoyl-CoA desaturase (SCD) activity. We aimed to test the hypothesis that high carbohydrate intake is related to SFA and MUFA in serum or AT in a Swedish population. Methods Fatty acid composition was measured in serum phospholipids (PL) and AT by gas chromatography in 63-year-old men ( n  = 299). Carbohydrate and alcohol intake was assessed (validated 7-day food records) in relation to total SFA, 16:0 (palmitate), 16:1 (palmitoleate), and estimated SCD activity (16:1n-7/16:0-ratio) in serum PL and in AT, respectively. Results Total carbohydrate intake was inversely associated with 16:0 in PL ( P  = 0.005), independently of BMI. Disaccharides were non-linearly (restricted cubic splines) and weakly associated with 16:1 and SCD activity in PL (nonlinear trend, P  ≤ 0.02) but not AT. Carbohydrate intake and SCD expression were not associated ( P  ≥ 0.08, n  = 81). Alcohol intake was, however, linearly associated with 16:0 in PL ( P  < 0.001), and with 16:1 ( P  < 0.001) and SCD activity ( P  ≤ 0.005) in both PL and AT. Conclusions Higher carbohydrate intake from sugar-rich foods or beverages was not clearly reflected by higher SFA or SCD activity in serum PL or AT. Alcohol was, however, associated with higher SFA and MUFA.

Background Family-based interventions may be a promising solution to increase children's physical activity, but there is a lack of knowledge on how to facilitate such interventions, specifically in socioeconomically disadvantaged areas. The aim of this study was to explore participants' and leader's experiences of the content and delivery of the family-based programme A Healthy Generation. Method A Healthy Generation is a health-promoting programme, for families with children in grade 2 (8-9 years) including siblings. Intervention components are: activity sessions, parental support groups, healthy meals and health information. The programme is delivered twice a week for one school year in collaboration with local municipalities, health coordinators and a variation of invited sport organisations in socioeconomically disadvantaged areas. Data was collected through participant observations during activity sessions, interviews with leaders (n = 11), and four focus groups with parents (n = 27) who had participated in the programme. Data was transcribed verbatim and analysed using content analysis. Results Leaders' and participants' experienced the programme to have an appealing ?Family-concept for joy, activity and integration?. The variation of activities provided opportunities and challenges to new interests, and the family approach were perceived as valuable for parental engagement and integration. To be ?A suitable programme for all participants?, activities directed to whole families needed to be simple and fun to keep all participants engaged, but also provide a progression for learning. Free and locally situated activities, meals and equipment for whole families facilitated participation, whereas lack of time and socio-cultural differences were barriers. The programme delivery consisted of ?A fruitful leadership collaboration? where health coordinators played an important role as coordinators of a heterogeneous group, so the invited leaders could focus on the content of their sport. They also provided participants with continuity and important reminders for participation during and in-between activity sessions. Conclusions Participants' and leaders' experiences of a family-based health promoting programme give insight to the importance of local involvement, collaborative leadership and a well-adjusted family programme for health promotion. The study also draws attention to opportunities and barriers for increased integration through health promotion aimed at families in socioeconomically disadvantaged areas.